Reconstructing Psychopathology: A Data-Driven Reorganization of the Symptoms in the Diagnostic and Statistical Manual of Mental Disorders

Abstract

In this study, we reduced the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to its constituent symptoms and reorganized them based on patterns of covariation in individuals’ (N = 14,762) self-reported experiences of the symptoms to form an empirically derived hierarchical framework of clinical phenomena. Specifically, we used the points of agreement among hierarchical principal components analyses and hierarchical clustering as well as between the randomly split primary (n = 11,762) and hold-out (n = 3,000) samples to identify the robust constructs that emerged to form a hierarchy ranging from symptoms and syndromes up to very broad superspectra of psychopathology. The resulting model had noteworthy convergence with the upper levels of the Hierarchical Taxonomy of Psychopathology (HiTOP) framework and substantially expands on HiTOP’s current coverage of dissociative, elimination, sleep–wake, trauma-related, neurodevelopmental, and neurocognitive disorder symptoms. We also mapped some exemplar DSM-5 disorders onto our hierarchy; some formed coherent syndromes, whereas others were notably heterogeneous.